Healthcare Reform

Tracking Legislative & Regulatory Change

From Congressional budget deals that tweak Medicare conversion factors to state bills redefining scope of practice, our healthcare reform posts explain how evolving statutes may influence medical decision-making, office work-flows, and payer negotiations. We connect the dots between headline votes and real-world clinic operations, spotlighting key provisions on payment models, telehealth flexibility, prior authorization, and interstate licensure compacts.

Analyzing Agency Rules & Guidance

The Centers for Medicare & Medicaid Services, the FTC, and state boards frequently publish rulemakings that affect reimbursement and compliance. Our articles summarize the practical pieces—effective dates, required disclosures, documentation standards—so physicians can adjust coding processes, update consent language, or join new alternative payment programs with minimal disruption.

Physician Autonomy & Practice Economics

Healthcare reform debates often pivot on consolidation, ownership restrictions, and value-based care incentives. We discuss how policies such as site-neutral payment proposals, surprise-billing regulations, and antitrust enforcement may influence the viability of independent practices versus hospital employment. Posts highlight contract clauses to watch, pitfalls in acquiring ancillary services, and strategies for sustaining revenue as payment structures evolve.

Practical Tips Rooted in Real Cases

Every commentary includes actionable insights—sample language for payer appeals when codes are retired, talking points for patient cost-of-care conversations after a benefit redesign, and checklists for updating compliance manuals. We draw on Dr. Jeffrey Segal’s dual perspective as surgeon and attorney to illustrate how one practice modified its financial policy after a change in balance-billing rules, or how another leveraged state innovation waivers to expand telehealth reach.

Key Topics We Discuss

• MACRA and QPP updates
• Interoperability & information-blocking rules
• Scope-of-practice expansion bills
• Federal price-transparency mandates
• State efforts to curb prior authorization delays

Surgeon Charges $117,000 – and Receives – for Assistant Fee

August 15, 2024October 3, 2014 by Jeffrey Segal, MD, JD

A couple of weeks ago, my car’s battery died. It was dead-dead. Was never going to take a charge.

AAA has a service where they will put in a new battery – instead of just giving you a jump. While the price seemed high- $128- it did not seem unreasonable. I’d be done. I wouldn’t have to turn this into a two step procedure, step 1: jump; step 2: get a new battery at a lower price elsewhere.

The next morning, the driver contracted by AAA called me. He made an error. Instead of charging my credit card $128, he accidentally charged $12,800. (That immediately made me feel inadequate about the tip I gave.) The driver said he was calling to let me know his company issued a credit. Whew.

Three Steps to Avoid Being Burned by Statistics in the Courtroom

August 15, 2024October 3, 2014 by Jeffrey Segal, MD, JD

Mark Twain, (and possibly Benjamin Disraeli in England) famously stated “There are three kinds of lies: lies, damned lies, and statistics.”

I just finished a 9 week MOOC – massive open online course in Medical Statistics offered by Stanford Medical School. The course was free and I highly recommend similar free online classes to all medical professionals. I must confess, though, I did not do the homework or take the final exam.

Finishing the course reminded me that statistics can be manipulated by the press, skilled lawyers, and others – often without malicious intent- to achieve a particular purpose. If an expert is delivering drivel against you on the witness stand, and he is waxing philosophic about statistics, the more you know about statistics, the better you’ll be able to defend against its misuse. While we could spend all day on the topic, let’s stick to basics.

Understanding duty and liability when you are on-call: Avoiding minefields

August 15, 2024September 19, 2014 by Jeffrey Segal, MD, JD

We continue with our series of general educational articles penned by one attorney, an MD, JD, giving you a view of the world through a malpractice plaintiff attorney’s eyes. This attorney is a seasoned veteran. The series includes a number of pearls on how to stay out of harm’s way. While I do not necessarily agree with 100% of the details of every article, I think the messages are salient, on target, and fully relevant. Please give us your feedback – and let us know if you find the series helpful.

The following questions came from a hand surgeon. They address situations that might arise when he is on-call at his local community hospital. These questions encapsulate issues that may affect anyone who consults to emergency rooms.

Let’s have a look:

1. I am on-call for hand surgery. A patient comes to the ER for a hand issue that the ER either treats or stabilizes. The ER physician gives them my name for follow-up, but no appointment is made. No contact is made from the ER to me. What are my duties to the patient and my potential liabilities?

Notes from a Plaintiff’s Attorney: Legal Issues When Dating Patients

August 15, 2024September 12, 2014 by Jeffrey Segal, MD, JD

Woody Allen notoriously maintained that “The heart wants what it wants.”

Mr. Allen thought that all that mattered when he married his daughter-in-law was his heart. But, from the standpoint of the public, the type of relationship sometimes matters as much as the bond between the two parties.

When there is a personal relationship between a doctor and a patient, society – in the form of state medical boards and the courts – will likely be in the bedroom as well.

Physician Report Cards: Can Chance Alone Make You Look Like a Killer

August 15, 2024September 12, 2014 by Jeffrey Segal, MD, JD

In our data driven word, you know what’s around the corner. Report cards for doctors based on clinical outcomes. But, statistics is a funny thing. Michael Blastland, a journalist with BBC, made precisely this point with his Go Figure Chance Calculator.

His premise:

“Imagine you are a hospital doctor. Some patients die. But how many is too many before you or your hospital are labeled killers?”

The Lilliputian Influence of CV Surgeon Report Cards on Referrals by Cardiologists

August 15, 2024September 4, 2014 by Jeffrey Segal, MD, JD

The holy grail for bean counters who focus on healthcare quality are tools for patients to help them find the best doctors. The argument goes: transparency will help drive quality initiatives; the data will help patients find the better doctors.

The process took off in 1986 when the Health Care Financing Administration released report cards of hospital-specific, risk-adjusted mortality rates for coronary artery bypass surgery. In 1991, New York picked up the baton by releasing stats for individual surgeons for risk-adjusted mortality rates for coronary artery bypass surgery. So, this data has been around for over two decades.

Sometimes You Settle a Case; Then You Get Sued Again. Crap.

August 15, 2024September 4, 2014 by Jeffrey Segal, MD, JD

We learned of a case where a patient was injured at a hospital. The treating doctor and the hospital were sued. Doctor decided to settle for policy limits – $1M. He believes he got out early and can sit on the sidelines. He reasonably believes his involvement in the case is over. And the hospital may be on the hook for a larger sum.

The hospital sues the doctor – arguing that if a jury orders them to pay, they want the doctor’s group to underwrite some of that payment. In other words, they want to be reimbursed some of the money a jury holds them liable.

What happened here?

Johns Hopkins to Pay $190 Million to Settle Claims Gynecologist Secretly Videoed Patients

August 15, 2024August 29, 2014 by Jeffrey Segal, MD, JD

Dr. Nikita Levy was a gynecologist affiliated with Johns Hopkins. He secretly photographed and videotaped women’s bodies in the examining room. When I say secretly, I mean without their knowledge or consent. Dr. Levy apparently wore a pen-like camera around his neck to accomplish the deeds.

In February, 2013, an employee alerted hospital authorities which forced the doctor to turn over his camera. Investigators discovered 1,200 videos and 140 images stored on servers in his home.

Avoiding liability when you’re asked to do more than you’re trained to do

August 15, 2024August 22, 2014 by Jeffrey Segal, MD, JD

Dirty Harry said, “A man’s got to know his limitations.”

The best general medico-legal advice is to do nothing that is not fully within your technical and knowledge comfort zone. When you move outside your specific area of expertise you will be held to the Standard of Care of an experienced and qualified practitioner in the area you have entered.

However, real life as a practicing physician has a tendency to not cooperate with the ideal.

Recently, two physicians raised questions about how to handle moving outside that ideal zone of practice, one in an elective setting and one in an emergency setting.

The Story of the Make a Wish Foundation

August 15, 2024August 8, 2014 by Jeffrey Segal, MD, JD

If you’re like me, you’ve certainly heard of the Make a Wish Foundation. What I did NOT know was the story of the man behind the Foundation – who he is and why he started it. The man is Frank Shankwitz. He was a Arizona Highway Patrol Officer. Frank built the foundation from … Read more

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